October 2006

This is Old Mill Pond in Windsor. It rained really hard all weekend. We went up to the pond a few times to make sure the dam looked okay.

This is the dam below Old Mill Pond.

An ad-hoc scoreboard on my behalf. LOM/LOL refers to ‘Little Old Man/Little Old Lady’. It’s well known in the department that LOL’s LOL (land on linoleum) during my shifts.

Gordon, Andy, and Pat at the ED early Sunday morning. Pat, Andy, and I had just brought up a drunk and head-injured-thus-combative teenager and three drunk friends. The ED staff was not happy with us.

One of our frequent flyers is a sweet old lady who used to weigh about four hundred pounds but now weighs about 300. I happened to see her nekkid on Sunday morning, a sight that none of my coworkers have seen. My colleagues at the FD felt I might need some help for the next few months. They made up this kit and taped it inside my locker.

The kit contains a Cuervo ad, some pictures of half nekkid women, some popsicle sticks, some rubbber bands, some tape, and a tourniquet. I was admonished not to leave the rubber bands on too long.

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This is O1, me, and O2 Sunday evening. The kids were happy to see me. Gosh, I look tired.

Final tally for the weekend; eleven calls. Five between 8 am and 6 pm on Saturday, three between 6 pm Saturday and 6 am Sunday, three between 6 am and 6 pm on Sunday.

Three IV starts, two paramedic intercepts.

One flu shot, courtesy of the fire department.

Only got blood on my clothes once; conveniently on the very last call.

Here are several pictures of the car involved in the accident on Saturday. These pictures are not grisly; no blood or gore. In several of the pictures the semicircular indentation made by the tree can be clearly seen.

Most of the pictures were taken at the garage the wreck was taken to. The roof, cut off during the extrication process, has been thrown back on top of the car for ease of transport. The front and rear bumpers has been placed under the car.

As it turns out, we saw the wreck being taken away by flatbed as we were returning from the hospital… That is the first picture.

I’m in the second quarter of a 48-hour shift at my paid department. No calls last night; par for the course for my paid department. I haven’t been on a call on this department for the last four or five shifts I’ve worked. On the other hand, my volunteer squad gets banged out every time I’m here; twice last night while I was here.

That was before. Just as I typed the above, we got toned out for a lift-assist; someone had fallen out of bed. We ended up taking them to the hospital; they had bumped their head on the way down. Nothing too serious, though. It was my partner’s call to work in back; the next one would be mine.

We had already had breakfast, done truck checks, and run all of the gas-powered equipment before the call came in.

We got back from the hospital and I came back to work on my blog post. Just as I sat down, we were toned to a car versus tree on the interstate. After we were on the way, dispatch called back and said this was a possible fatality. I asked dispatch to put the helicopter on standby. In a minute, dispatch radioed that the helicopter had been grounded due to the weather.

We got to the accident scene. The car was wrapped around the tree. The car had become airborne and hit the tree, bottom first. The car was u-shaped and the roof and floor of the car were within about two feet of each other. One could see the lower part of the driver’s leg visible through through the hole where the windshield had been. Looking in through the back window, one could see the back of the driver’s head. The driver was breathing loudly; agonal respirations. Someone called dispatch and asked for a paramedic on scene.

I put on my turnout gear and helmet and worked my way into the back of the car. The driver was wedged between the window and the floor. I was able to reach up and hold the patient’s head to open the airway and hold c-spine precautions. I was able to feel the carotid pulse with my right hand.

The fire department cut the roof off the car and we moved the patient to a backboard. A member of the local rescue squad started to suction blood and mucus out of the patient’s airway and assist ventilations with a bag-valve mask while other people started to strap the patient to a backboard. I went to the ambulance and prepared to start IVs.

The patient was put inside and we all got to work. We cut off the patient’s clothes and did a rapid trauma assessment. There was some instability in the patient’s rib cage but it seemed that a head injury was the most significant problem.

I put a huge 14-gauge catheter in the patient’s left arm and started running fluids. The paramedic arrived and tried twice to intubate the patient without success. I suggested that we should put in a Combitube and the paramedic agreed. I dropped in the tube and inflated the cuffs; the paramedic bagged the patient through the tube while I checked for proper placement by auscultating for epigastric sounds (none) and lung sounds (good on one side; diminished on the other probably due to a pneumothorax). Various local rescue squad members got off the ambulance and we got under way direct to the Level-1 trauma center.

I bagged the patient all the way to the hospital while the paramedic did a secondary survey. I patched through to the hospital (called on the radio to alert them to our arrival) and declared a trauma alert.

We got to the hospital and wheeled the patient into the resuscitation room. The room was full; sixteen people were waiting for our arrival. We transferred the patient to the resus room table and were done.

I watched the resus team work for a while and then went out to clean the truck. There was blood on the floor and seats; there was trash from various tools on every surface. Various bags and tools were strewn around. It took about twenty minutes to clean up and mop out the back of the truck.

The paramedic said nice things about how we handled the call. My partner was very impressed with my skill putting in the IV and Combitube.

A bit later, we had another car accident; the patient was probably okay but had some back pain. We put the patient on a board and took them to the hospital.

My Wilderness EMT certification expires at the end of this month. I have to renew my EMT certifications in Vermont, New Hampshire, and with the National Registry by March. The state certifications run in sync with the National Registry. Providers recert every two years in March. My Wilderness EMT is also a two year cert, expiring on the 24 month anniversary of its issue. I completed WEMT (a course including EMT-Basic) in October of 2002, so I come up in October for the wilderness cert.

Recertification for the states and the National Registry is an arcane process. Due to the labyrinthine rules and requirements governing recertification that differ between the various organizations, I am not entirely sure of my actual requirements to renew yet. I know that I can not recert the same way I did last time. Last time I recertified, I was an EMT-Basic and only had a license in Vermont. Now I am an Intermediate with a license in both Vermont and New Hampshire.

Then, I was able to recertify my National Registry through completing a 24-hour Refresher Training Program (RTP) and compiling 36 hours of other continuing education. The wilderness add-on was another 8 hours of refresher and counted towards the continuing education.

This time, as far as I can tell, I have to complete the following items in time to send everything in to arrive by March 31;

– Complete 24 hours of New Hampshire protocol update transition
– Complete some other number of hours of New Hampshire protocol transition; this may be zero, twelve, or sixteen hours. I’ve heard rumors of each.
– Complete a 24 hour RTP that will apply to all three applications
– The National Registry requires that I amass 48 hours of other continuing education. Vermont wants 40. New Hampshire needs 48. Much of the continuing education time overlaps between the three agencies.
– Get my regional medical director (a doctor) to sign off on my application to New Hampshire
– Complete the New Hampshire EMS practical portion of the EMT-Intermediate exam. This is three or eight simulated scenarios designed to test Intermediate skills.

I think I have 24, maybe thirty hours of CE at present. Off-hand, I know I took a 16-hour Advanced Coronary Life Support class in the spring and that I’ve had a bunch of in-service time at my paid department.

I have no idea as to how much time I still need for any of the agencies. I’m pretty sure need to attend at least five days of class between now and March.

And that’s in addition to the last four days. I completed the 24 hour RTP and the 8 hour wilderness refresher between Saturday morning and today at SOLO, Stonehearth Open Learning Opportunities, in Conway, New Hampshire.

Saturday I was a little worn out, having worked at my paid department on Friday night. During my shift, we were toned out four times; the last two times were at 02:15 and 04:20. The four-twenty call was a transfer from the local hospital to the trauma center twenty-two miles away. I went right from the last call of the shift to the three hour drive to class.

The drive was okay, really. I went up over the Kangamagus Highway and went through early enough that the traffic was really quite easy. I hadn’t realized until this week that my class, initially scheduled some time ago, fell on Columbus Day weekend.

Class started at 0900 on the first morning. I was on time, though bleary.

Our instructor for the EMT refresher training program was Bill Kane, the Director of Education at SOLO. I was very happy; Bill was the instructor during my initial medical course; Wilderness First Responder, taken in June 1999. He is an excellent instructor and many of his statements from that initial class still resonate and direct me on scenes today. The things that he taught in that beginning class seven years ago still directly affect my patient care today. He is an engaging and entertaining teacher and I have had the pleasure and honor of having him as an instructor the majority of my times on campus.

My class had Bill Kane for the three days of the EMT RTP. Today, Bill Kane went on to orientate new WEMT and WFR classes. We had a different instructor for the so-called ‘Wild Day’; the wilderness add-on recertification day, today. We spent the morning in lecture and the other half of the day outside, mostly in scenarios.

I’m home again, now. It would seem that I need to find someplace that is offering Pre-Hospital Trauma Life Support (PHTLS) and Pediatric Education for the Pre-hospital Professional (PEPP). I’ve had each of these before but taking them again will add 32 hours of CE, usable in all three states. My boss at my paid squad has also said that when the date gets closer, we can look at my still outstanding requirements and that he will specifically target those needs.

Anyway, here are a few pictures. If you click on the picture, it will take you to a Flickr page. If you then click on the ‘All Sizes’
icon, it will take you to a larger version of the picture (the size I uploaded, but smaller than the actual original).

This is the main building at SOLO.

This is the front door to the main building. It’s hand carved. The entire buliding is completely custom and designed and built by SOLO staff over the years.

This is inside the main building.

Bill Kane teaches. If you look at the ‘original’ version, you can read the blackboard.

On Monday, class got out at 15:40, early. I drove up to Pinkham Notch and hiked west towards the summit of Mt. Washington. I made it to the headwall of Huntington Ravine where I decided I needed to turn back to avoid being caught above treeline after dark.

This is some random waterfall just up from the AMC lodge.

This looking up the Tuckerman Ravine trail. And I do mean up.

This was my first time on the east side of the mountain without snow. The rocks, though found on the west side of the mountain, were a surprise since I was used to walking up on a smooth, if steep, snow path.

This is a brook running down Huntinton Ravine at a trail crossing.

This is looking up Huntington Ravine from the Fan. This photo is from a camera pointing at least 45 degrees up. Odell’s, Pinnacle, and Central gullies, for you ice climbers.

Looking east down Huntington Ravine.

I covered five and a half miles in two hours and forty minutes. This is an average of 1.8 mph which includes a total elevation gain and loss of 2,034 feet each.

Bxiie's Photos

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This is a blog about whatever strikes me but primarily about emergency services and computers. I am a firefighter/EMT and a technology professional in rural Vermont. EMS, Fire, Oracle, UNIX. AEDs, Windows.